title: Predictive factors for long-term survival in patients with clinically significant portal hypertension following resection of hepatocellular carcinoma.
abstract: BACKGROUND
  Hepatic resection for hepatocellular carcinoma (HCC) is not currently recommended for patients with clinically significant portal hypertension (PHT); however, recent studies have shown similar post-operative outcomes between patients with and without clinically significant PHT.
  
  
  OBJECTIVE
  To clarify the post-operative prognostic relevance of clinically significant PHT in Child-Pugh A cirrhotic patients.
  
  
  METHODS
  A total of 100 Child-Pugh A cirrhotic patients who underwent curative resection of HCC were eligible for this analysis. Patients were divided into two groups: PHT group (n=47) and non-PHT group (n=53).
  
  
  RESULTS
  Clinicopathological variables showed no significant differences except for prothrombine time. Liver-related complications were significantly higher in the PHT group (P=0.015), and the 5-year overall survival rate was significantly higher in the non-PHT group (78.7 vs. 37.9%, P<0.001). The proportion of patients who died because of complications of cirrhosis was significantly higher in the PHT group (P=0.001). Multivariate analysis indicated that the presence of clinically significant PHT was the most powerful adverse prognostic factor for overall survival. Multivariate analysis of the 47 patients with clinically significant PHT indicated that gross vascular invasion and non-single nodular type were poor prognostic factors. The 5-year survival rate of patients with single nodular type and without gross vascular invasion (n=17) was 78.4%.
  
  
  CONCLUSIONS
  In Child-Pugh A cirrhotic patients, the presence of clinically significant PHT was significantly associated with post-operative hepatic decompensation and poor prognosis after resection of HCC. However, in patients with clinically significant PHT, those with single nodular tumours lacking gross vascular invasion may be good surgical candidates.
authors.affiliation: Department of Surgery, Yonsei University Health System, Seoul, Korea.
authors.forename: Gi H
authors.initials: GH
authors.lastname: Choi
authors.forename: Jun Y
authors.initials: JY
authors.lastname: Park
authors.forename: Ho K
authors.initials: HK
authors.lastname: Hwang
authors.forename: Dong H
authors.initials: DH
authors.lastname: Kim
authors.forename: Chang M
authors.initials: CM
authors.lastname: Kang
authors.forename: Jin S
authors.initials: JS
authors.lastname: Choi
authors.forename: Young N
authors.initials: YN
authors.lastname: Park
authors.forename: Do Y
authors.initials: DY
authors.lastname: Kim
authors.forename: Sang H
authors.initials: SH
authors.lastname: Ahn
authors.forename: Kwang-Hyub
authors.initials: KH
authors.lastname: Han
authors.forename: Chae Y
authors.initials: CY
authors.lastname: Chon
authors.forename: Woo J
authors.initials: WJ
authors.lastname: Lee
mesh_terms: D006528:Carcinoma, Hepatocellular / Q000601:surgery*; D005544:Forecasting / Q000379:methods*; D006801:Humans; D006975:Hypertension, Portal / Q000150:complications / Q000503:physiopathology*; D008103:Liver Cirrhosis / Q000503:physiopathology*; D008113:Liver Neoplasms / Q000601:surgery*; D015999:Multivariate Analysis; D011183:Postoperative Complications / Q000209:etiology / Q000503:physiopathology*; D011379:Prognosis; D011517:Prothrombin Time; D056910:Republic of Korea; D016019:Survival Analysis